As community lifelines that overcome limited resources to serve complex patients, essential hospitals can find value in learning from evidence and experience to improve care delivery.
The Agency for Healthcare Research and Quality (AHRQ) recognizes hospitals committed to this process of continuous improvement as learning health systems (LHSs). The agency defines an LHS as a system in which “internal data and experience are systematically integrated with external evidence, and that knowledge is put into practice.”
Transforming a health system into an LHS does not happen overnight. This iterative process takes time and commitment, but it can result in better patient outcomes and quality at lower costs.
Association member Denver Health, in Denver, understands the commitment it takes to achieve this transformation. The health system’s journey to become an LHS, documented in a new AHRQ case study series, began in the early 2000s, when leadership adopted Toyota’s Lean methodology principles. Denver Health applied this methodology, which helps organizations work to maximize customer value while minimizing waste, to the three core LHS components: data, culture, and workforce.
“If you improve performance, you improve outcomes. From a health system perspective, a patient perspective, or a provider perspective, everyone always wants to do better, right?” — Robin Wittenstein, EdD, Denver Health CEO
With a patient mix that is 75 percent Medicaid, Medicare, dual eligible, or uninsured, Denver Health works to provide high-quality care with limited resources. So, the hospital’s investments in infrastructure must focus strategically on improving the information providers can access. To this end, Denver Health shifted to a single electronic health record (EHR) platform, a change that helped encourage cancer screenings at the primary care clinic. Using a single EHR platform allows providers to see quickly who is due or overdue for screening and improves the ability to track and access systemwide data in real time.
In addition to improving data infrastructure, Denver Health worked to create a culture of continuous improvement within the organization. System leaders adopted the idea that everyone within the system can contribute to the whole organization’s success and used this principle to foster staff participation at all levels. Efforts to encourage participation include monthly meetings between senior leaders and community clinic teams, as well as whiteboard displays at every clinic that list the systemwide and clinic-specific initiatives that are in progress. These efforts and others emphasize the open culture of learning that Denver Health has created across its system, which motivates all employees to be involved in the process of continuous improvement.
Finally, Denver Health’s transformation to an LHS required a dedication to workforce engagement. The health system has worked to create incentives for staff to seek opportunities to enhance system processes, such as creating committees to review quality improvement projects. Health system leaders also launched a leadership training program, which requires individuals hired on a leadership track to complete a core curriculum that includes a diverse set of courses. Encouraging workforce commitment to innovation and improvement helped to involve all staff in the process of becoming an LHS.
Investments in data, culture, and workforce allow Denver Health to operate as a constantly improving learning health system. Transforming and maintaining an LHS was an extensive undertaking, but health system leaders see it as vital to their organization. Creating a system of continuous learning provides all Denver Health employees “the tools they need to adapt and change in ways that create lasting value for patients and the health system.”
More information, research, and case studies on learning health systems can be found on AHRQ’s website.